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Objective: Among the opioids used for treating dyspnea in cancer patients, the evidence for clinical use of fentanyl is not adequate. We report a case that suggested that fentanyl citrate patch improved dyspnea caused by lung metastasis of ureteral cancer.Case: An 86-year-old female was scheduled to start opioids for dyspnea caused by exacerbation of lung metastasis from ureteral cancer. Morphine hydrochloride was not chosen due to renal dysfunction, and oxycodone hydrochloride extended-release tablet was initiated. However, one day after starting medication, the patient refused to take the tablet because of vomiting. Given the difficulties in using morphine hydrochloride and oxycodone hydrochloride extended-release tablet, fentanyl citrate patch 0.5 mg/day was started for the purpose of improving dyspnea. The dose was eventually increased to 1.0 mg/day. Dyspnea improved and she was discharged.Conclusion: This case suggested the possibility that use of fentanyl citrate patch may be effective for dyspnea. Fentanyl citrate patch may provide one option when other drugs such as morphine hydrochloride and oxycodone hydrochloride cannot be used. However, since this is a report of a single case, further verification is required to clarify the effectiveness of fentanyl citrate patch for dyspnea.
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<b>Objective: </b>From September 2009, the Department of Pharmacy of Kitasato University Kitasato Institute Hospital started operation room services, and the pharmacist in charge also responds to the inquiries from the operation room staff (doctors and nurses) concerning pharmaceutical compounds. In the present study, we collected the inquiries and analyzed their contents in order to understand the information of pharmaceutical compounds required by the operation room staff.<br><b>Methods: </b>The inquiries from operation room staff received between October 2009 and March 2012 were collected and the contents were analyzed.<br><b>Results: </b>A total of 625 inquiries (mean, 20.8 inquiries per month) were received. Regarding the contents of inquiry, the most frequent inquiry was on “the presence or absence of the stock” (70.7%), followed by “drug information” (17.0%), “handling of controlled substances” (5.9%), and “handling of non-controlled substances” (4.2%). For “the presence or absence of the stock,” the most common pharmaceutical compounds inquired were antibacterial agents, anesthetics, and infusion fluids. For “drug information,” the contents were diverse, ranging from drug efficacy to operation method, whether compounds are included in hospital drug list, in-hospital preparations, and drug selection. For “handling of non-controlled substances,” the most frequent inquiries were associated with the expiration date after unsealing.<br><b>Conclusion: </b>The most frequent inquiry from the operation room staff was on “the presence or absence of the stock,” and the common subject of inquiry was presumably pharmaceutical compounds frequently used at the time of surgery. The analysis showed that the operation room requires a wide range of information.
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<b>Objective: </b>As part of the revision on remuneration for medical services in 2012, a new system has been implemented to allow an additional fee for inpatient pharmaceutical services to be added to the basic hospitalization fee.<br><b>Methods: </b>We at Kitasato University Kitasato Institute Hospital satisfied all institutional requirements for the new system and were preparing to introduce it from April 2012; however, there was concern about the increased workload due to the additional work of preparing diaries for pharmaceutical services used in calculating the additional fee.<br><b>Results: </b>We therefore developed a database titled Diary System for Inpatient Pharmaceutical Services for the preparation and management of diaries. This system allows pharmacists from various divisions to enter data simultaneously and realizes the unified management of records of services performed at various places in the pharmacy.<br><b>Conclusions: </b>Since entered data are automatically reflected in the inpatient pharmaceutical service diary and the monthly summary, an advantage compared to paper diaries in terms of efficiency may be expected. Furthermore, the monthly summary of the number of service hours by ward and service type may also be used for service analysis.
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<b>Objective: </b>In the intensive care unit (ICU), drugs are administered in sequence as the conditions of the patient change rapidly, and there are often cases where many injections are administered simultaneously. For this reason, it is important to quickly select the appropriate administration route. In this study, we prepared a quick reference table for incompatibilities of frequently used and highly important injections in the ICU (referred to as the “quick reference table”) that will enable selection of the appropriate administration route, and we investigated the status of use and usefulness of this quick reference table.<br><b>Methods: </b>The drugs included in the quick reference table were extracted from prescription records from May to October 2009, and these were finalized by discussions with the nurses in the ICU. Three reference materials were used: <i>Manual on the Supervision of Injection Preparation </i>(3rd Edition), <i>Data Search on Injection Incompatibilities 2009</i>, and <i>MICROMEDEX</i>®. The survey was conducted with all 12 nurses in the ICU after 4 months of distributing the quick reference table.<br><b>Results: </b>The quick reference table included 57 pharmaceutical items, and compatibility was classified into 10 categories. The quick reference table was prepared as one A3 page for convenience. The retrieval rate of the survey was 100%. The average number of years of practical experience as a nurse was 12.2 years, and 11 out of 12 nurses used the quick reference table. Of the 11 nurses who used the table, 6 answered that it was “very useful,” while 4 answered that it was “useful.” All 11 nurses who used the quick reference table answered that they “consulted the pharmacists less frequently.”<br><b>Conclusion: </b>Satisfactory evaluations were obtained with regard to the details included in the quick reference table, and the table was estimated to be highly useful and important even for ICU nurses with many years of experience. Furthermore, it was suggested that the quick reference table was also useful in reducing the workloads of the pharmacists.
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<b>Objective: </b>The sports community has placed its great hope on pharmacist since the establishment of the Accredited Sports Pharmacist System. Thus, we constructed an anti-doping database for pharmacist so that pharmacist can support appropriate drug use and contribute to the sports community.<br><b>Methods: </b>The database was constructed by using Microsoft®Access 2007, based on our previously prepared anti-doping list.<br><b>Results: </b>686 prescription drugs and 268 ingredients for non-prescription drug were registered in the data base. It was able to retrieve the advisability of use for athlete, blood half-life and the other notes of the drugs easily and promptly.<br><b>Conclusion: </b>We confirm that pharmacist can provide drug information easily, promptly and from the viewpoint of pharmaceutics by utilizing the database including necessary information for anti-doping.
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<b>Objective</b>: We studied whether the statements made in the “contradicted combinations” package inserts for medications used at the Kitasato Institute Hospital, Kitasato University (henceforth, “the hospital”) and the combinations of medications listed were consistent.<br><b>Methods</b>: We studied whether both the “contraindicated combinations” in the package insert and the listed combinations were consistent, and when they were not, we telephoned the pharmaceutical company that did not list it as a “contraindicated combination” and inquired as to the reason it was not listed as such.<br><b>Results</b>: 1,347 pharmaceutical products were the target of this study, and among these there were 147 products that had contraindicated combinations listed in its package insert, and there were 239 combinations of contraindicated combinations. Among the 147 products, most were cardiovascular drugs (40 drugs, 27.2%), followed by central nervous system drugs (30 drugs, 20.4%). Among the 239 combinations, there were 47 (19.7%) combinations that were inconsistent, and the reasons for the inconsistency were 1) because they would become unusable in the event of an emergency, 2) because there are no safety issues, etc.<br><b>Conclusion</b>: In this study, it was clear that pharmaceuticals that are inconsistent in their contraindicated drug combinations are by no means few in number. A lack of uniformity in what is listed in the package insert regarding contraindicated combinations, which is a public document, is not something to be at all desired, and we believe it is necessary to create consistency by clarifying the standards for listing contraindicated combinations in order to avoid confusion in clinical settings in the future.
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<b>Objective</b>: At Kitasato Institute Hospital, Kitasato University (henceforth, the hospital), the first edition of an antimicrobial use guidebook (henceforth, the guidebook) was produced in 2000. This time, the Pharmaceutical Department’s members on the hospital’s Infection Control Committee (ICC) took the lead and revised the guidebook so that it better conforms to clinical conditions and assessed the guidebook they created.<br><b>Methods</b>: A Working Group (WG) consisting of two ICC Pharmaceutical Department members and two members of the Medical Products Information Office staff examined the items to be listed in the guidebook. These items were approved by the ICC and then assigned to physicians and pharmacists to be written up. A questionnaire survey was conducted on the physicians and pharmacists in the hospital as to their assessment of the content and the conditions of use of the guidebook created.<br><b>Results</b>: In the revised edition, “Antimicrobials PK/PD,” “TDM,” “Empiric Therapy for Infections in Each Department,” etc. have been added, the physicians wrote “Empiric Therapy for Infections in Each Department” and everything else was written by the WG. The return rate of the questionnaire was 65.7% (<i>N</i>=99), and the guidebook utilization rate was 75.4%. Frequently viewed items were “List of Antimicrobials Used In-Hospital,” “How to Administer Medication during Decreased Renal Function,” “Empiric Therapy for Infections in Each Department,” etc. by the internal medicine physicians, “List of Antimicrobials Used In-Hospital” and “How to Administer Medication during Decreased Renal Function,” etc. by the surgeons, and “Classification of Antimicrobials,” “List of Antimicrobials Used In-Hospital,” “When Renal Function is Decreased,” “TDM,” and “Empiric Therapy for Infections in Each Department,” etc. by the residents. Furthermore, there were no items deemed “not necessary for inclusion” for a clear reason. As to be expected in this guidebook, 72.3% of all respondents mentioned it was “a source of information on basic antimicrobial use” and next, “a source of information for treating infections outside one’s area of specialty.”<br><b>Conclusion</b>: The items listed in the guidebook are thought to be appropriate, and its usage conditions are also good. As they are specialists on antimicrobials, the pharmacists playing a central role while cooperating with the physicians on the ICC led to the creation of a highly useful guidebook.
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<b>Objective</b>: In the Drug Informatics in Department of Pharmacy, Kitasato Institute Hospital (hereinafter “the hospital”), we have had question-and-answer sessions regarding doping agents (banned drugs) among doctors and other workers and prepared an Anti-doping Quick Reference List (hereinafter “the list”), facing an urgent need to provide precise information quickly.<br><b>Methods</b>: The list consists of drugs adopted by the hospital and over-the-counter drugs according to package inserts, interview forms, and other sources of information.<br><b>Results</b>: In the list, hospital and over-the-counter drugs are classified into three categories in terms of a doping test: (1) “Non-banned” (drugs that can be used), (2) “Banned” (drugs that cannot be used), and (3) “Suspected” (unclear drugs) with their half lives for elimination as an indicator of the disappearance time from the body and divided by medicinal effect. In addition, we indicated any drug for which the Therapeutic Use Exemption (TUE) application (hereinafter, TUE application) is required before use.<br><b>Conclusion</b>: The list prepared in this investigation offers many benefits, including precise and quickly available information on banned and non-banned drugs, ease in suggesting alternatives, and avoidance of failure in TUE application.
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<b>Object: </b>A multicenter survey was conducted to investigate the status of use of supplements and related problems in patients with diabetes mellitus.<br><b>Methods: </b>A questionnaire was mailed to institutions where members of the Drug Information Section, Tokyo Hospital Pharmacists Association, worked, and hospitalized patients with diabetes mellitus were surveyed with a questionnaire.<br><b>Results: </b>The response rate of the questionnaire was 85%, and 22 patients reported taking supplements. The most common motivation to purchase supplements was a recommendation from an acquaintance, followed by a recommendation from a family member and TV. Only 9.1% of the patients consulted healthcare professionals when purchasing supplements. The patients who did not follow the dosage and administration instructions and those who were not aware of precautions regarding proper use accounted for 31.8% and 63.6%, respectively. The proportion of patients who did not inform their physicians about the use of supplements was 65.2%, and 4.5% reported some health damage (rash).<br><b>Conclusion: </b>Our results revealed that supplements were used without careful consideration and were not administered properly, suggesting that scientific evaluation of efficacy and safety was warranted in future studies. It is important for pharmacists to actively collect information on patient use of supplements and share the information within the medical team.
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<b>Objective</b>: To quickly collect and provide information on package insert revisions, packaging changes, discontinuation of drug manufacturing and distribution, and other information without fail.<br><b>Methods</b>: Information was collected with the use of a drug information service site (SAFE DI) managed by an organization formed by 15 pharmaceutical wholesalers (SAFE Co., Ltd.). The information obtained was processed into a house journal and provided to the department of pharmacy and other hospital personnel via an employees-only website (hospital LAN).<br><b>Results</b>: Before the introduction of the SAFE DI, incomplete or delayed information collection sometimes forced personnel to urgently cope with packaging changes or discontinuation of drug manufacturing and distribution and assume a heavy workload. Introduction of the system allowed quick collection and dissemination of such information without fail.<br><b>Conclusion</b>: The recently introduced SAFE DI contributes to qualitative improvement in collection and dissemination of information. Introduction of such a system may also be useful in other hospitals.